A child is brought to the emergency room with a high fever, photophobia, and a headache. What important sign would a nurse use to check for meningeal irritation?


• Meningeal irritability is assessed by eliciting positive Brudzinski’s and Kernig’s signs, as well as an inability to flex the neck forward (nuchal rigidity).

• Brudzinski’s sign: After forced flexion of the neck there is a reflex flexion of the hip and knee and abduction of the leg.

• Kernig’s sign: When the nurse flexes a patient's hip and knee at 90-degree angles, pain and resistance are noted.

• Incorrect: Cullen's sign is the presence of superficial edema and bruising around the umbilicus. It suggests acute pancreatitis or an intraabdominal bleed.

• Incorrect: Ortolani's sign is a distinctive "clunk" heard after flexing and abducting a newborn's hips. This is indicative of hip dysplasia.

• Incorrect: McBurney's sign is deep tenderness or pain at McBurney's point, which is one-third the distance from the right anterior iliac spine and the navel. This is indicative of acute appendicitis.

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